When Should Antibiotics Be Used To Treat Dental Abscesses?

A painful dental abscess should be treated as quickly as possible, and in some cases, the recommended treatment involves the use of antibiotics.

Because abscesses are typically serious and will not go away on their own, the treatments that are recommended will vary depending on the level of pain, swelling and the risk that it could spread to other parts of the head and jaw.

Alongside dental treatment, antibiotics such as amoxicillin are sometimes used, but it is important to understand not only when they are effective at helping relieve symptoms and avoiding further issues, but also when they should not be used.

Why Are Antibiotics Used To Treat Abscesses?

A dental abscess is a bacterial infection found either inside a tooth, in the gums or in the surrounding structural parts of the teeth, which tends to cause intense toothache, the formation of pus, swelling and tender gums.

Because it is always caused by a bacterial infection, antibiotics are typically used to reduce the infection, stop it from returning following other dental treatment or avoid it spreading further in the mouth or around the body, which could potentially lead to a medical emergency.

In most cases of simple dental abscesses, draining the pus, removing the infected dental pulp and a short course of antibiotics are the main course of treatment, but there are cases where antibiotics are used first.

This typically includes rarer dental infections, where the antibiotic treatment needs to be started as soon as possible to avoid life-threatening complications, cases where the dental treatment needs to be delayed for whatever reason, when people are immunocompromised and at a greater risk of infection, and also people with diabetes.

When Are Antibiotics Typically Not Used?

Typically, antibiotics are recommended in cases where there is a risk of serious complications caused by a dental abscess infection spreading throughout the mouth and the body.

Usually, this is seen in patients with significant swelling, fever, eyesight troubles and difficulties opening the mouth either due to swelling or intense pain.

Antibiotics in general should only be used in emergency situations, to treat conditions such as acne that will not resolve without antibiotics, where they will speed up recovery significantly or avoid complications. 

This is to avoid the risk of antibiotic resistance where certain bacteria become immune to certain types of antibiotics, increasing the risk of medical complications..

Most people who are otherwise healthy and there is a low risk of an infection spreading will typically not be prescribed antibiotics, and our consultation process will ensure that a prescription is the right option for you before you take it.

In those cases, the main course of action is to book an appointment with a dentist to resolve the issue whilst taking over-the-counter painkillers to help ease the toothache that the abscess can sometimes cause.

Which Antibiotics Are Used To Treat Dental Abscesses?

The main antibiotic prescribed to help treat dental abscesses is amoxicillin, a form of penicillin that takes the form of a short course of tablets.

It is part of the same family of antibacterial medications that Alexander Fleming accidentally discovered in 1928 that revolutionised medical treatment in the 20th century.

Amoxicillin has been available and widely used since 1977 and has been used to treat a wide variety of bacterial infections. It is one of the most commonly prescribed antibiotics for children and its effects are very well-known by this point.

The typical dose we recommend is one 500 milligram tablet taken three times a day for seven days, for a total of 21 doses.

This will help ease the pain and swelling whilst waiting for a dental appointment, but it is essential to contact a dentist as soon as possible to drain the pus, identify the cause and provide a long-term solution for your teeth.

When Is Amoxicillin Not Prescribed?

Other than situations where it is not believed to be effective, there are some cases where amoxicillin will not be recommended, for which we offer alternative antibiotic treatments that can help instead.

The most common reason why it might be avoided is in the case of allergic reactions to any kind of penicillin medicine; this will appear on your medical records but it should also be discussed during any consultations regarding dental abscess treatment.

Similarly, if you have glandular fever, there is a risk that amoxicillin could cause or exacerbate the rashes that are typical of the viral disease, so it may not be recommended until the disease clears up.

As well as this, if you have liver or kidney problems, it could make antibiotics more difficult for the body to process and so it may not be recommended.

Finally, if you are required to take any blood or urine tests, amoxicillin might be avoided simply because it could potentially change the results, although this is not always the case.

Are There Any Alternatives To Amoxicillin?

If you are allergic to penicillin then the main alternative course of medication is metronidazole, an alternative antibiotic medication that is typically used as an alternative to amoxicillin and is considered to be as effective for dental abscesses.

Metronidazole is typically used to treat rosacea, infected insect bites and pelvic inflammatory disease, but it is also effective at treating and managing mouth infections.

These infections are typically caused by anaerobic bacteria, which do not need oxygen to grow.

Whilst the tablets are slightly larger, containing 400 milligrams of metronidazole rather than 300 milligrams of amoxicillin, the dosage schedule is the same; you will take a tablet three times a day for seven days.

One important aspect of metronidazole that a consultant will warn you about is that it reacts strongly with alcohol, to the point that the effect has been compared to disulfiram, a drug primarily used to treat alcohol dependence.

Alcohol should not be taken whilst also taking metronidazole, which may include some types of liquid medication that use alcohol as a solvent, and it should be avoided for two days after treatment as the antibiotic may still be in your system.